Behav. Sci. Insomnia Flashcards Preview

Abbey MSII Unit 3 > Behav. Sci. Insomnia > Flashcards

Flashcards in Behav. Sci. Insomnia Deck (21):
1

define insomnia

complaint of dissatisfaction with sleep quantity or quality, associated with:
-difficulty initiating, maintaining, or early morning awakening with inability to return to sleep
-causes distress/impairment
-at least 3 nights per week in the last 3 months

2

dyssomnia

sleep disorder characterized by problems in timing, quality, or amount of sleep (insomnia is classified as this)

3

parasomnia

sleep disorder characterized by abnormalities in physiology or behavior associated with sleep

4

epidemiology of insomnia

1/3 of adults, 10-15 with impairments, women more often, increases with age

5

etiology of insomnia

-excitatory neurotransmitters in excess at night (NE, serotonin, dopamine, histamine)
-inhibitory neurotransmitter deficiency at night (loss of GABA, melatonergic, adenosinergic)
-use of CNS stimulants (caffeine)
-withdrawal of sedating agents (alcohol, barbiturates, benzos)
-medical conditions (pain, pulmonary disease, endocrine disorders)
-psychiatric causes (MDD, bipolar, generalized anxiety/PTSD)

6

where does NE come from?

locus ceruleus

7

where does serotonin come from?

raphe nucleus

8

where does dopamine come from?

ventral tegmental area

9

where does histamine come from?

tubermammillary nucleus

10

which symptoms commonly lead to insomnia?

anxiety (getting caught up in thoughts about past events, excessive worrying, overwhelmed) also anxiety about not falling asleep

11

effects of insomnia

decreased quality of life, complaints of impaired daytime performance, self-medication, risk of psychiatric disorder

12

management of insomnia step 1

diagnosis, informed consent and education

13

management of insomnia step 2

behavioral counseling (sleep hygiene/stimulus control)

14

sleep hygiene

"ten basic rules for a good night's sleep" (regular sleep schedule, 20 min exercise in morning, avoid smoking and alcohol, adjust bedroom environ, etc)

15

management of insomnia step 3

sleep restriction therapy, cognitive therapy (talking through and imagery), behavioral therapy (diary/log book, progressive relaxation, self hypnosis)

16

management of insomnia step 4

pharmacotherapy
1. OTC: melatonin, antihistamines
2. Rx agents/nonhabit forming (antihistamines, melatonin1+2 agonists (ramelteon, tasimeltean)
3. Rx agnets/mild-habit forming (benzodiazepine, receptor agonists (zolpidem, zaleplon, ezopiclone, orexin 1+2 antagonists, suvorexant)
4. Rx agents/habit forming (benzodiazepines (triazolam, temazepam, flurazepam) and off label options

17

pharmacokinetics of sleeping pills:
faster absorbed = ?
shorter half life = ?
longer half life = ?

faster absorbed allows = faster absorbed allows faster sleep onset
shorter half life allows = the drug to leave your system by the morning but risks less hours of sleep
longer half life allows = longer sleep, but greater chance of being under the influence in the morning

18

what do patients with restless legs get to treat insomnia?

D2 agonists

19

which patients cannot get sedatives?

apnea patients

20

antagonizing what creates deeper sleep patterns?

5HT2a

21

antagonizing what promotes a more accurate circadian clock?

5HT1d and 7